【摘要】 目的探讨超声引导下微波消融(microwave ablation,MWA)治疗乳腺多发良性结节的效果。方法回顾性分析2015年7月～2016年7月我院163例乳腺多发良性结节的临床资料,根据患者意愿72例在超声引导下行MWA(MWA组),91例行传统开放手术(传统组),比较2组患者手术时间、术中出血量、切口愈合时间、术后1 d疼痛评分及术后并发症发生率,同时对MWA组定期术后超声随访,评估吸收效果。结果与传统组比较,MWA组中位术中出血量少[3(1～8)ml vs.12(3～35)ml,Z=-10.703,P=0.000],中位切口愈合时间短[4(3～7)d vs.11(7～45)d,Z=-11.031,P=0.000],术后1 d中位疼痛评分低[1(0～5)分vs.3(0～8)分,Z=-5.779,P=0.000],术后并发症发生率低[1.3%(1/72)vs.8.6%(8/92),χ2=4.158,P=0.041]。MWA组1例术中乳晕区出现烫伤,范围1.4 cm×0.8 cm;传统组1例术后出血(弹力绷带压迫止血),7例术后积液(其中6例同时合并切口感染)。功率40 W时,消融时间分别为(61.0±39.1)、(38.1±22.2)、(58.9±32.2)s。实性、囊性、囊实性结节术后6个月完全消融率分别为23.8%(91/382)、26.1%(17/65)、16.7%(2/12),术后12个月完全消融率分别为44.2%(169/382)、44.6%(29/65)、41.7%(5/12)。结论超声引导下MWA治疗乳腺多发良性结节创伤小、并发症发生率低,术后消融灶吸收好。更多还原

【Abstract】 Objective To evaluate the efficacy of ultrasound-guided microwave ablation( MWA) for multiple-sited benign breast nodules. Methods Clinical data of 163 patients with multiple benign breast nodules proved by core needle biopsy before operation were retrospectively analyzed. There were 72 cases of ultrasound-guided MWA( MWA group) and 91 cases of traditional open surgery( operation group). The operation time,intraoperative bleeding,incision healing time,pain score on the first day after operation and post-operative complications rate between the two groups were analyzed. At the same time,the MWA group was followed up to evaluate the absorption effect with postoperative ultrasound regularly. Results The MWA group was significantly associated with relatively less median post-operative bleeding [3( 1-8) ml vs. 12( 3-35) ml,Z =-10. 703,P = 0. 000],shorter median recovery time [4( 3-7) d vs. 11( 7-45) d,Z =-11. 031,P = 0. 000],lower median pain score at the first postoperative day [1( 0-5) points vs. 3( 0-8) points,Z =-5. 779,P = 0. 000]and lower post-operative complications rate[1. 3%( 1/72) vs. 8. 6%( 8/92),χ2= 4. 158,P = 0. 041],as compared to those in the operation group. In the MWA group,1 case developed scald in areola area,ranged 1. 4 cm × 0. 8 cm. In the operation group,1 case had postoperative bleeding( receiving elastic bandage compression hemostasis),and 7 cases had postoperative effusion( 6 of which were complicated with incision infection). At the power of 40 W,the ablation time were( 61. 0 ± 39. 1) s,( 38. 1 ± 22. 2) s,and( 58. 9 ± 32. 2) s,respectively. At 6-month after treatment,the complete ablation rate of nodules were 23. 8%( 91/382),26. 1%( 17/65),and 16. 7%( 2/12),respectively. At 12-month after treatment,the complete ablation rate of nodules were 44. 2%( 169/382),44. 6%( 29/65),and 41. 7%( 5/12),respectively. Conclusion The ultrasound-guided MWA is a sufficient procedure for benign breast nodules,which can be performed with less damage and lower incidence of complications in comparison to that of traditional open surgery.更多还原